Acceptance and adoption of text messaging

1 Co-Hosted by the National Institutes of Health and AcademyHealth Text messaging between providers and patients living with HIV in South Carolina: Barriers and facilitators to implementation Virginia Fonner, PhD, MPH (Co-PI) Department of Psychiatry and Behavioral Science Medical University of South Carolina Background • ~20,000 people living with HIV in South Carolina • Only ~50% are retained in continuous HIV-related medical • ~750 new infections per year • Sustained HIV treatment healthy patients  no onward transmission • Communication vital to patient engagement and retention Background • MUSC HIV Clinic: ~1,200 patients • ~250 patients receive case management services • An estimated 95% have cell phones; 75% have smart phones • Current clinic operations: • Landline telephones used for communication, but: – Patients decline to answer calls from blocked numbers – Voice mailboxes are full or have not been set-up – Providers play phone tag all day – Patients ask to be texted, not called Hypothesis and aim • Hypothesis: Having the capacity to text between patients and clinic providers (specifically case managers and pharmacists) will improve: • Linkage and retention in clinical care • Patient satisfaction with clinical services • Research Aim: To understand acceptability, preferences, and barriers/facilitators to texting among patients and providers • Included assessing preference for encrypted app (Qliq) vs standard texting Qliq vs plain texting Ease of use Contacts Sending a message Privacy Text messaging On all phones Same as on phone Type and hit “send” Qliq App (free for patients) • Separate contacts • Account requires name and phone number or email Type and hit “send” Based on phone • privacy settings • • Receive Yes notifications Passcode protected Can remotely delete messages if device is lost or stolen HIPAA compliant (messages are encrypted) Yes, might need to configure settings Qliq Can change status (“online,” “away,” or “do not disturb”) Can see when someone has read a text Can request acknowledgement Standard way of typing and sending messages Can also send pictures Methods • Semi-structured in-depth interviews with patients (n=12) and providers (n=14) • Purposeful sampling (variation of provider role and patient age/gender) • Interviews included: • Open-ended questions related to CFIR domains • Demonstration of a secure texting app (Qliq) • Close-ended Likert scale questions related to intervention acceptability • Interviews transcribed, coded using deductive and emergent codes • Thematic analysis Methods • Formative phase of larger, mixed-methods study Phase 1: Developmental formative evaluation Phase 2: Implementation of text/video chat (12 months) Phase 3: Interpretative formative evaluation Results: Sample characteristics Patients (n=12) Providers (n=14) Characteristic % in sample Role N (%) Gender 42% male 50% female 8% gender fluid Social Support Provider (43%) Race/ethnicity 83% African American Medical Provider (36%) Age, mean (range) 39.5 (23-57) Support Staff (21%) Phone access 100% smart phones (Case Managers, Social Workers, Outreach) (Physicians, PAs, Pharmacists) (Nurse Administrators, Coordinators, Program Support) Quantitative Results: Acceptability 10 Strongly agree (5) Strongly disagree (1) I would like to use this form of communication frequently Providers and patients should have the capacity to text with each other Trying to implement a system to allow texting between patients is too complex and not worth the time and risk Most patients would be interested in communicating by text with their case manager or pharmacist = patients = providers 4.1 4.4 4.0 4.4 1.6 1.9 4.3 4.5 No significant differences (p